Educating the public on the intersection of the death penalty and severe mental illness.

Thursday, February 21, 2008

The Role of Medications (or Lack Thereof) in Recent Acts of Violence?

An editorial that appeared earlier this week in the Dallas Morning-News ("Guns aren't only thing to blame in tragedies," February 18, 2008) sheds some light on why those suffering from mental illness might choose to stop taking their medications:"With clockwork predictability, we zeroed in on the source of the weapons used by the gunman in last week's appalling slaughter in an Illinois campus classroom. Where did he buy the guns? Why were they so easy to get? Can't we do more to keep guns away from people who are potentially disturbed?

All reasonable questions, albeit politically difficult to answer. Here are some other questions, though, that perhaps should also be asked:

Why did he stop taking his medicine? Wasn't he being monitored? Can't we do more to make people stay on the drugs that keep them sane and stable?

I'm not saying these questions, which go to the heart of privacy and civil liberty, are any easier to resolve than the intractable and shopworn battle over firearms. But somebody, at least, ought to be asking. ...""...mental disorders are frequently part of the equation in the murky psychology of crime. For a lot of patients, sticking with the drugs can mean the difference between stability and chaos. 'One of the main goals of our program is to convince them to stay on their meds,' said Dallas County court appellate judge Kristin Wade, who oversees a special program that offers selected minor offenders strict supervision in lieu of jail time. 'I'd say 90 percent of them do not want to.'

The reasons are varied: Some don't like the side effects; some simply don't have the wherewithal to keep up with doctor visits and pharmacy refills. Many people just quit taking their medicine in the perverse belief that, because it makes them feel better, they don't need it any more.

'I always analogize it to antibiotics,' Judge Wade said. 'And then, there's some part of your brain that's in denial about the reality of mental illness.'

Courts can make keeping up with medicine a condition of bond or probation, but there are no guarantees. Some anti-psychotic medicine can be administered by monthly injection, Judge Wade said, which can help patients stay on track.

But, by and large, we expect people to maintain their own health. If they neglect their medicine and get sick – well, that's their lookout, right?

Perhaps. Yet last week, a New York truck driver was charged with manslaughter for running down two people after he suffered a seizure behind the wheel because he didn't take his medication. In that case, there were serious legal consequences for his neglect.

I'm not suggesting that someone could have followed around Steve Kazmierczak to make sure he took his pills, and I'm certainly not intimating that people with diagnosed mental illness don't deserve our compassion.

We need to recognize, though, that many people with severe mental illness need these drugs to function in society. It's more than a minor issue of personal preference to unilaterally decide to stop taking them.

Mr. Kazmierczak's case, perhaps understandably, set off a fresh round of gun-control debate.

If he had stayed on his meds, he might not have gone looking for guns in the first place."

Contributors

Facts about Mental Illness and the Death Penalty

· The State of Texas ranks 47th nationally in terms of per capita spending on mental healthcare, according to the National Alliance on Mental Illness. It ranks 1st in executions (more than 400 since 1982).

· Around 30 percent of those incarcerated in Texas prison or jails have been clients of the state’s public mental health system. (TX Department of Criminal Justice)

· The U.S. Supreme Court has prohibited the death penalty for people with mental retardation, but it has not excluded offenders with severe mental illness from this punishment. Texas law also does not adequately protect those with diminished capacity from a death sentence.

· At least 20 individuals with documented diagnoses of paranoid schizophrenia, bipolar disorder, and other persistent and severe mental illnesses have been executed by the State of Texas. Many had sought treatment before the commission of their crimes, but were denied long-term care.